Healthcare Provider Details

I. General information

NPI: 1578897476
Provider Name (Legal Business Name): THE GALEN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 09/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 SEA WINDS DR
SANTA ROSA BEACH FL
32459-4395
US

IV. Provider business mailing address

536 SEA WINDS DR
SANTA ROSA BEACH FL
32459-4395
US

V. Phone/Fax

Practice location:
  • Phone: 850-797-2123
  • Fax: 850-391-5100
Mailing address:
  • Phone: 850-797-2123
  • Fax: 850-391-5100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number85762
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number85762
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number85762
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number85762
License Number StateFL

VIII. Authorized Official

Name: DR. EDMOND K SAFARIAN
Title or Position: CEO
Credential: MD
Phone: 850-797-2123